<?php
$form = $this->beginWidget('bootstrap.widgets.TbActiveForm', array(
    'id' => 'horizontalForm',
    'type' => 'horizontal',
    'enableAjaxValidation' => false,
//    'action'=>Yii::app()->createUrl('');
        ));
?>
    

        <?php echo $form->errorSummary($model); ?>
<br>
<br>
        <div class="control-group ">
            <label class="control-label" >No.SPTPD </label>
            <div class="controls">
                <input type="text" class="span3" value="HTL140200003" >
              </div>
            </div>
        
       <div class="control-group ">
              <label class="control-label" >NPWPD</label>
          
                <input type="text" class="span1" style="width: 30px;" readonly >
                <input type="text" class="span1" style="width: 20px;" readonly >
                -
                <input type="text" class="span2" readonly >
                -
                <input type="text" class="span1" style="width: 20px;" readonly >
                -
                <input type="text" class="span1" style="width: 30px;" readonly >
            </div>
        


        <div class="control-group ">
            <label class="control-label">Wajib Pajak </label>
            <div class="controls">
                <input type="text" class="span4" readonly >
                
            </div>
                    </div>
        <div class="control-group ">
            <label class="control-label">Alamat </label>
            <div class="controls">
                <input type="text" class="span4" readonly >
                
            </div>
                    </div>
        <div class="control-group ">
            <label class="control-label">Kelurahan/Desa </label>
            <div class="controls">
                <input type="text" class="span3" readonly >
            </div>
                    </div>
        <div class="control-group ">
            <label class="control-label">Kecamatan </label>
            <div class="controls">
                <input type="text" class="span3" readonly >
            </div>
                    </div>
        <div class="control-group ">
            <label class="control-label">Kabupaten </label>
            <div class="controls">
                <input type="text" class="span3" readonly >
            </div>
                    </div>
        <div class="control-group ">
            <label class="control-label">No.Rekening </label>
            <div class="controls">
                <input type="text" class="span2">
                        <?php
                        $this->widget('bootstrap.widgets.TbButton', array(
                            'type' => 'info',
                            'label' => 'F1',
                            'htmlOptions' => array('id' => 'btn_pilih_lokasi')
                        ));
                        ?>
            </div>
           </div>

        <div class="control-group ">
            <label class="control-label" >Nama Rekening</label>
            <div class="controls">
                <input type="text" class="span3" readonly>
                
            <label class="control-label" >Cara Hitung</label> 
                <?php
        echo $form->DropDownList($model, 'no_telepon', array(
            'prompt' => 'Pilih',
            '0' => 'Self Assessment (SA)',
            '1' => 'Office Assessment (OS)',
            ), array('class' => 'span3'));
        ?>
            </div>
        </div>

                <div class="control-group ">
            <label class="control-label" >Kecamatan </label>
            <div class="controls">
                <input type="text" class="span3" style="width:20px;" >
                <?php
                $this->widget('bootstrap.widgets.TbButton', array(
                    'id' => 'btn_pilih_Pejabat',
                    'type' => 'primary',
                    'label' => 'F1',
                ));
                ?>
            <label class="control-label" >Kelurahan</label> 
                <input type="text" class="span3" style="width:20px;">
            </div>
        </div>
        
             <div class="control-group ">
            <label class="control-label" >Kabupaten </label>
            <div class="controls">
                <input type="text" class="span3">
                
                <label class="control-label">Kode Pos </label>
                <input type="text" class="span2" readonly >
            </div>
        </div>
        
        <div class="control-group ">
            <label class="control-label" >Telepon </label>
            <div class="controls">
                <input type="text" class="span2" >               
            </div>
        </div>
        
        <div class="control-group ">
            <label class="control-label" >Bidang Usaha</label>
            <div class="controls">
      <?php
        echo $form->DropDownList($model, 'no_telepon', array(
            'prompt' => 'Pilih',
            '0' => '00.Lain-Lain',
            '1' => '01.Hotel',
            '0' => '02.Restoran',
            '1' => '03.Hiburan',
            '0' => '04.Reklame',
            '1' => '05.Galian Golongan C',
            '1' => '06.Air Tanah',
                ), array('class' => 'span3'));
        ?>
            </div>
        </div>
        
        <div class="alert alert-success">B. Pemilik/Pengelola </div>
        
                <div class="control-group ">
            <label class="control-label" for="TestForm_textField">Nomor Bukti Diri </label>
            <div class="controls">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                -
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                -
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                -
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                -
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
                -
                <input type = "text" name="no_op_input[]"  class="span1" id="nop1" style="width:20px;">
        
            </div>
        </div>
        <div class="control-group ">
            <label class="control-label" >Nama Lengkap </label>
            <div class="controls">
                <input type="text" class="span3" readonly >
                
                <label class="control-label" style="width:120px; ">Alamat Wajib Pajak </label>
                <input type="text" class="span4" readonly >
            </div>
        </div>

                <div class="control-group ">
            <label class="control-label" >Kecematan </label>
            <div class="controls">
                <input type="text" class="span3" readonly >
                
                <label class="control-label" style="width:120px; ">Kelurahan/Desa </label>
                <input type="text" class="span4" readonly >
            </div>
        </div>
        
                <div class="control-group ">
            <label class="control-label" >RT </label>
            <div class="controls">
                <input type="text" class="span1" style="width:20px; " readonly >
                
                RW 
                <input type="text" class="span1" style="width:20px;" readonly >
                <label class="control-label">Kode Pos </label>
                <input type="text" class="span2"  readonly >
            </div>
        </div>

             <div class="control-group ">
            <label class="control-label" >Kabupaten </label>
            <div class="controls">
                <input type="text" class="span3" readonly >
                
                <label class="control-label">Kewarganegaraan </label>
                <input type="text" class="span2" readonly >
            </div>
        </div>
        
                        <div class="control-group ">
            <label class="control-label" >Telepon </label>
            <div class="controls">
                <input type="text" class="span2" >
                
            </div>
        </div>
        
        <div class="control-group ">
            <label class="control-label" >Jabatan </label>
            <div class="controls">
                <input type="text" class="span3" >        
            </div>
        </div>
        

<div class="alert alert-success">C. Pencatatan</div>
        
<div class="control-group ">
            <label class="control-label">Cara Hitung</label>
            <div class="controls">
                <?php
        echo $form->DropDownList($model, 'no_telepon', array(
            'prompt' => 'Pilih',
            '0' => 'Self Assessment (SA)',
            '1' => 'Office Assessment (OA)',
            
                ), array('class' => 'span1'));
        ?>

                <label class="control-label" >NPWPD</label>
                <?php
        echo $form->DropDownList($model, 'no_telepon', array(
            'prompt' => 'Pilih',
            '0' => 'P',
            '1' => 'I',
            '2' => 'R',
            
                ), array('class' => 'span1'));
        ?>
                <input type="text" class="span1" style="width: 20px;" >
                -
                <input type="text" class="span2" value="000005" >
                -
                <input type="text" class="span1" style="width: 20px;" value="01" >
                -
                <input type="text" class="span1" style="width: 40px;" >
            </div>
        </div>
        
<div class="control-group ">
            <label class="control-label" >Petugas </label>
            <div class="controls">
                <input type="text" class="span2" value="Dany Erlangga" >
            </div>
        </div>

<div class="control-group ">
            <label class="control-label" >NIP </label>
            <div class="controls">
                <input type="text" class="span3" value="123070123" >
            </div>
        </div>

<div class="alert alert-success">D. Pendataan</div>

<div class="control-group ">
            <label class="control-label" >Petugas </label>
            <div class="controls">
                <input type="text" class="span2" value="Dany Erlangga" >
            </div>
        </div>
<div class="control-group ">
            <label class="control-label" >NIP </label>
            <div class="controls">
                <input type="text" class="span3" value="123070123" >
            </div>
        </div>


<div class="control-group ">
            <label class="control-label" >Tanggal Pendataan </label>
            <div class="controls">
                <input type="text" class="span2"  >
            </div>
        </div>



       

        <div class="form-actions">
            <?php
            $this->widget('bootstrap.widgets.TbButton', array(
                'buttonType' => 'submit',
                'type' => 'primary',
                'label' => $model->isNewRecord ? 'Simpan' : 'Save',
            ));
            ?>
            <?php
            $this->widget('bootstrap.widgets.TbButton', array(
                'buttonType' => 'submit',
                'type' => 'primary',
                'label' => $model->isNewRecord ? 'Batal' : 'Reset',
            ));
            ?>

        </div>
    

<?php $this->endWidget(); ?>